Urinary Tract Infections - World Health Organization
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
Urinary Tract Infections Leading cause of morbidity and health care expenditures in persons of all ages. An estimated 50 % of women report having had a UTI at some point in their lives. 8.3 million office visits and more than 1 million hospitalizations, for an overall annual cost > $1 billion.
Virulence Host factors
Infection No infection
UTIs may occur either because of
the pathogenicity of the organism,
the susceptibility of the host or a
combination of both factors
Peter Ulleryd, Sahlgrenska University Hospital, Göteborg, SwedenVirulence factors of the gram-negative uropathogens E. coli and P. mirabilis
Host defenses
Antibacterial properties of urine Anti-adherence mechanisms
• Osmolality (extremes of • Bacterial interference
Urinary Catheterization
high or low osmolalities (naturally endogenous
inhibit bacterial growth) bacteria in the urethra,
• High urea concentration vagina, and periurethral
region)
• High organic acid alters these • Urinary oligosaccharides
concentration
• pH (have the potential to
detach epithelial-bound E.
defensive mechanisms coli
• Tamm-Horsfall protein
Miscellaneous (uromucoid): coating of E.
coli by this protein might
• Mucopolysaccharide lining of the bladder prevent attachment
• Urinary immunoglobulins
• Spontaneous exfoliation of uroepithelial cells with bacterial
detachment
• Mechanical flushing of micturitionCatheter-Associated UTI Risk of bacteriuria is ~ 5%/day (long term catheter bacteriuria is inevitable). 40% of nosocomial infections Most common source of gram-negative bacteremia. Etiology: E.coli, Proteus, Enterococcus, Pseudomona, Enterobacter, Serratia, Candida
Duration of cahteterization
Daily Prevalence of Acquired Bacteriuria in Patients
Receiving Bladder Drainage by Indwelling Urethral Catheters
Garibaldi et al. Factors predisposing to bacteriuria during indwelling
uretheral catheterization. N Engl J Med 1974;291:215.Risk Factors Associated with the Development of CAUTI Increasing duration of catheterization Not receiving system antibiotic therapy Female sex Diabetes mellitus Older age Rapidly fatal underlying diseases Nonsurgical diseases Faulty aseptic management of the indwelling catheter Bacterial colonization of drainage bag Azotemia (serum creatinine concentration > 2 mg/dl Catheter not connected to a urine meter Periurethral colonization with uropathogens
Asymptomatic Bacteriuria
• The best way to avoid having patients
develop IUC-related UTIs is to avoid initial
catheter insertion or to minimize the
duration of catheter use.
• UTIs are the tenth most likely reason for a
Medicare patient to have an unplanned
readmission to the hospital
Lee EA Perm J 2011CA-UTI reduction initiatives began in late 2007 by creation of a catheter management and removal policy: • nurse and care partner education • check off on sterile technique • insertion competency • strict guidelines on catheter and perineal skin care • mandatory removal of the urinary catheter at 5 days unless a counter-order was written.
Community-Acquired UTI
E. coli
S.epidermidis &
gram neg enterics
Enterococcus
Proteus
S.saprophyticus
K.pneumoniaeNosocomial UTI
catheter associated
Short Term Long Term
E.coli
Enterobacter E.coli
Enterococcus Proteus
Candida
Proteus
S.aureus Providencia
Morganella
Pseudomonas
PseudomonasBy patient age
FQ resistance
By patient sex
With timeSmithson A EJCMID 2011
Prevalence (%) of ESBL producing isolates by species in
Assistance Publique Hopitaux de Paris long-term-care facilities
(2001–2005).
Nicolas-Chanoine et al. CMI 2008Risk factors for ESBL-producing Escherichia coli
and Klebsiella pneumoniae
Mendelson et al EJCMID 2005Multivariate logistic regression analyses: • Fluoroquinolone use days: OR 1.33 (1.04– 1.69) P=0.02 • History of UTI: OR 2.56 (1.37–4.78) P=0.003
Multidrug-Resistant Organisms in LTCF
• MDRGN were isolated more frequently than MRSA
or VRE throughout the study period.
• More than 80% of MDRGN isolates were resistant
to ciprofloxacin, TMP/SMX, and
ampicillin/sulbactam.
• Resistance to three, four, or more antimicrobials
were identified among 122 (67.8%), 47 (26.1%), and
11 (6.1%) MDRGN isolates, respectively.
O’Fallon J Gerontol. 2009Acquisition of Multidrug-Resistant Gram-
Negative Bacteria within a LTCF Population
O’Fallon E et al ICHE 2010• There were significantly higher antibiotic
costs, re-consultation costs and total costs
for patients whose infections were
resistant to at least one antibiotic.
IJAA 2009Appropriateness by Site of Infection
50
Appropriate
Inappropriate
40
p=0.76
30
20
10
0
ry l e t t r
i nary at o ti na
i ssu r oa T rac t he
Ur ir es h l O
e sp o int oft T se/T nit a
R r S o Ge
st in/ r/N
Ga Sk Ea
Lautenbach, Arch Intern Med 2003;163:601What factors or conditions are likely to have determined UTI?
What measures should have been put in place to prevent it?
You can also read
